ISSN: 2149-2247 | E-ISSN: 2149-2549

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Erciyes Med J: 41 (2)

Volume: 41  Issue: 2 - 2019

EDITORIAL COMMENTS
1.Antibiotic Resistance: A Global Concern; Current Situation and Action Plans
Jafar Soltani, Ann Versporten, Herman Goossens
doi: 10.14744/etd.2019.32656  Pages 125 - 127
Abstract | Full Text PDF

2.Clinical Effects of Fine-Tuning: Thyroid Hormone Replacement
Ayşa Hacıoğlu, Züleyha Karaca
doi: 10.14744/etd.2019.65481  Pages 128 - 129
Abstract | Full Text PDF

INVITED REVIEW
3.Emerging Infections and Future Threats
Nicola Petrosillo
doi: 10.14744/etd.2019.57805  Pages 130 - 134
Emerging infections represent a concern especially when their increase is rapid and their mortality is high. They can be caused by previously undetected or unknown pathogens, by known agents affecting new geographical sites or new populations, or by re-emerging agents whose incidence of disease had significantly declined in the past. The main causes of emerging infectious disease (EID) spread include crowding; mobility (tourism, migration, asylum seekers, and refugees); centralization of food production and supply and new food vehicles; war, famine, and displacement; and change in vector distribution and susceptibility. Another important issue regarding EIDs is the source of pathogens, with 60.3% of cases from a non-human animal origin (zoonotic pathogens). If emerging viral infections represent a concern mainly in underdeveloped areas of the world, the emergence of antimicrobial resistance is a growing concern worldwide especially in developed and high-income countries, where misuse and overuse of antibiotics among humans and in the veterinary setting, including animal feeding, artificially created the selection of resistant strains. Future threats include not only diseases caused by viral agents, such as the case of Ebola virus disease periodical re-emergence, but also infections with antibiotic-resistant bacteria. It is estimated that in 2050, deaths due to antimicrobial-resistant infections will be higher than those due to cancer.

ORIGINAL ARTICLE
4.Filamin B and CD13 Are Components of Senescent Secretomes That May Be Involved in Primary (Stress Induced) and Paracrine Senescence of Mesenchymal Stromal Cells
Tiziana Squillaro, Servet Özcan, Nicola Alessio, Mustafa Burak Acar, Giovanni Di Bernardo, Mariarosa Ab Melone, Gianfranco Peluso, Umberto Galderisi
doi: 10.14744/etd.2019.37974  Pages 135 - 140
Objective: In the present study we aim to evaluate whether some of the proteins previously identified in the secretome of senescent bone marrow (BM)- and adipose (A)-mesenchymal stromal cells (MSCs) could be involved in regulation of senescence phenomena.
Materials and Methods: Among the identified proteins, we selected Filamin B (FLNB) and Aminopeptidase N (CD13) that were exclusively found in the secretome of senescent cells. We silenced their mRNA expression in BM-MSCs by means of RNA interference technology and induced acute senescence by hydrogen peroxide treatment. Our goal was to evaluate if FLNB or CD13 silencing may affect onset of senescence.
Results: Our preliminary data showed that CD13 protein could be a key factor involved in the regulation and determination of both primary and paracrine induced senescence in human BM-MSCs. On the other hand, Filamin B seems not to be involved in the determination of primary senescence whereas its presence could be part of the mechanism that regulates the senescence induction in human BM-MSCs by paracrine signaling.
Conclusion: Our study provides a useful base for identifying the complex extracellular protein networks involved in the regulation of MSC cellular senescence.

5.Diffusion-Weighted Magnetic Resonance Imaging Value in the Detection and Differentiation of Bone Tumors and Tumor-Like Lesions
Mostafa Emara, Ayman Nada, Maged Hawana, Mohamed Elazab, Ahmed Mohamed Shokry
doi: 10.14744/etd.2019.68878  Pages 141 - 147
Objective: The aim of this study was to evaluate the ability of diffusion-weighted magnetic resonance imaging (MRI) and its corresponding apparent diffusion coefficient (ADC) values in the detection, characterization, and discrimination between different types of bony lesions.
Materials and Methods: Patients were evaluated by conventional and diffusion-weighted MR images. Diffusion was carried out using the b values of 0, 500, and 1000, and then the ADCs were generated.
Results: The average ADC value of benign lesions was approximately 1.84×10–3 mm2/s±0.33, while that of malignant lesions was approximately 1.17×10–3 mm2/s±0.44; p<0.001. The receiver operating characteristic (ROC) curve analysis produced a cut-off value for the detection of malignancy of 1.47×10–3 mm2/s with 89.5% specificity and 79.5% sensitivity.
Conclusion: Diffusion-weighted imaging combined with ADC values is considered a useful tool that can be added to the conventional MRI sequences for detection, differentiation, and characterization of different bony lesions.

6.Zinc, Vitamin D, and TSH Levels in Patients with Vitiligo
Sara Saniee, Armaghan Ghareaghaji Zare, Afsaneh Radmehr
doi: 10.14744/etd.2019.40316  Pages 148 - 152
Objective: Vitiligo is an acquired depigmenting autoimmune disorder of the skin. The disease association with autoimmune diseases, such as thyroid diseases, has been reported. Previous studies among patients with vitiligo have suggested possible correlation between zinc and vitamin D levels with conflicting results. Here we compared the thyroid hormones, zinc, and vitamin D levels in patients with vitiligo with normal healthy subjects.
Materials and Methods: We recruited 98 patients with vitiligo and 98 age- and sex-matched healthy subjects visiting dermatology clinics during spring and summer 2017. Serum zinc and vitamin D levels as well as thyroid stimulating hormone (TSH) and thyroid peroxidase antibody (anti-TPO) were measured and compared between groups.
Results: Patients with vitiligo had significantly lower zinc (p=0.01) and higher anti-TPO levels (p=0.02) with no difference in vitamin D (p=0.73) and TSH levels (p=0.31). Patients with vitiligo had also significantly higher rate of increased TSH (p=0.02) and positive anti-TPO (p=0.01). We observed no significant correlation between serum levels of vitamin D, zinc, and TSH with age, gender, and disease duration in patients with vitiligo.
Conclusion: Patients with vitiligo, compared to healthy subjects, had lower serum zinc levels, but not vitamin D levels. Increased TSH levels were higher in patients with vitiligo with non-significantly higher anti-TPO AB as suggested to be related to autoimmune disease.

7.Efficacy of N-acetyl Cysteine in Patients with Dyspepsia with Negative Helicobacter pylori Infection
Naser Hajavi, Khatereh Isazadeh Far, Moharram Eslami, Afshin Habibzadeh, Mehdi Hemmati, Crystal Lu
doi: 10.14744/etd.2019.34445  Pages 153 - 157
Objective: In this study, we evaluated the efficacy of NAC in dyspepsia symptoms in Helicobacter pylori (H. pylori) negative dyspeptic patients.
Materials and Methods: In this randomized clinical trial, 85 patients with functional dyspepsia without H. pylori infection underwent treatment with a proton pump inhibitor (PPI) pantoprazole 40mg daily (n=41) with or without NAC 600mg twice a day (n=44) for 8 weeks. Patients’ clinical symptoms and change in the severity of dyspepsia symptoms were compared between the groups.
Results: Common symptoms were epigastric pain and bloating. The intervention group had significantly more cases with retrosternal burn and bloating and less early satiety as compared to the control group. In both intervention and control groups dyspepsia severity was significantly reduced from 5.26±2.06 and 4.68±2.81 to 1.87±1.38 and 2.22±2.04, respectively (p<0.001). The percent of reduction in dyspepsia severity in intervention group was significantly higher than control group (-66.25±23.44% vs. -50.14±35.02%, p=0.01).
Conclusion: PPI is an effective treatment for functional dyspepsia and NAC as an adjuvant to a PPI is a safe medication that can increase the response rate and treatment efficacy.

8.Identification of a Novel Mitochondrial DNA Sequence Variation within the Human Mitochondrial DNA Control Region in a Population of Aegean Population
Aylin Köseler, Sehime Gülsün Temel, Mahmut Cerkez Ergoren
doi: 10.14744/etd.2019.39269  Pages 158 - 163
Objective: Environmental impacts, history as well as established cultural regulations, and many more other factors had shaped broadly diverse structure of human genetic patterns. A control region of human mtDNA has served as a good genetic determination marker in many fields such as evolutionary studies and forensic genetics. The allelic variations of mtDNA have been studied in many populations including Turkish populations. Previous studies in Turkish populations lacked large cohorts. In this study, non-coding hypervariable regions of human mitochondrial DNA with extended population of Turkish individuals from Aegean region have been investigated.
Materials and Methods: To detect sequence variants in human mtDNA control region, 100 unrelated Turkish subjects were examined.
Results: The outcomes revealed 13 variable sites in hypervariable region I (HVRI) and 20 variable sites in hypervariable region II (HVRII). Polymorphisms within HVRI were detected at the positions of 16173 (C>A) and 16175 (A>G) with the allelic variation frequencies of 53% and 60%, respectively. A novel nucleotide transversion from cytosine to adenine at 16173 position was detected. Only 35% of subjects were aligned with the Cambridge Reference Sequence for the poly-cytosine tract that locates between 303 and 309 nucleotides, whereas 60% of individuals had 8 and 15% of them had 10 cytosine polynucleotides. 263G and 73G polymorphisms were evaluated with higher frequencies for the HVSII region.
Conclusion: Overall, results indicate that the determination of genotype distributions and allelic variations frequencies of human mitochondrial genome are significant to characterize admixture populations from different ethnic origins.

9.Prostate Cancer Screening and Health Beliefs: A Turkish Study of Male Adults
Naile Bilgili, Yeter Kitiş
doi: 10.14744/etd.2019.45762  Pages 164 - 169
Objective: Attitudes and beliefs of people affect health behaviors. Understanding the individual experiences with regard to prostate cancer (PCa) and PCa screening of the participants is important. Thus, researchers and health professionals can take advantage of the results obtained to make an attempt to increase the participation in PCa early diagnosis services. The aim of this research is to determine the personal attitudes and beliefs of Turkish men related to PCa and screening.
Materials and Methods: The study design was a cross-sectional survey of 650 Turkish men, 40 years old and older. Data were gathered using the Prostate Cancer Screening–Health Belief Model Scale, a knowledge test for prostate cancer screening, the International Prostate Symptom Score questionnaire, and a researcher-developed personal information form. A correlation and logistic regression analysis (LRA) were used for evaluation.
Results: It was determined that the knowledge score had a strong positive correlation with the symptom score and the seriousness perception and that it had a poor positive correlation with the susceptibility and the benefit perceptions. The prostate symptom score had a strong positive correlation with the susceptibility, seriousness, and motivation perception. It was determined that age (OR=1.057, 1.017–1.099 CI [confidence interval] 95%), a higher symptom score (OR=0.21; 0.009–0.050 CI 95%), and a history of prostate problem in the family (OR=1.086; 1.037–1.137 CI 95%) affected getting an examination in the past.
Conclusion: Age, the education level, a prostate symptom score, family history of prostate problems, and motivation perceptions have been found to be important predictors of men’s PCa screening behavior.

10.Determination of Adiponectin, Tumor Necrosis Factor-Alpha, and Adhesion Molecules in Alzheimer’s Disease
Sumru Savaş, Burcu Güler, Fulden Saraç
doi: 10.14744/etd.2019.60420  Pages 170 - 174
Objective: Though the data regarding the mechanisms behind neurodegeneration in addition to amyloid plaques and neurofibrillary tangles are not clear, there are emerging data for inflammation and microvascular changes to have contribution to the pathology of Alzheimer’s disease (AD). The relationships between numerous biomarkers also need to be investigated. This study aimed to assess inflammatory marker tumor necrosis factor-alpha (TNF-α), adiponectin (a modulator of anti-inflammation), and potential microvascular markers for AD including both intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in Turkish patients with AD and healthy elderly subjects, and the relationships among the variables in patients with AD.
Materials and Methods: In this study, 46 patients with AD and 30 cognitively healthy controls over 60 years of age from the outpatient clinics of Ege University were included. Adiponectin, ICAM-1, VCAM-1, and TNF-α were evaluated by enzyme-linked immunosorbent assays.
Results: The median adiponectin level in the AD group was higher than in the controls (p=0.002). Median VCAM-1, ICAM-1, and TNF-α values for patients with AD and the controls were similar. There were positive correlations between VCAM-1 and both TNF-α and adiponectin in the patients with AD (r=0.540, p<0.001, and r=0.301, p=0.044, respectively).
Conclusion: Though a dramatic rise of adiponectin, and associations of VCAM-1 and both TNF-α and adiponectin in subjects with AD were shown, the clinical significances of these peripheral measurements need to be further investigated.

11.Safety and Effectiveness of Thrombolytic Therapy Compared with Standard Anticoagulation in Subjects with Submassive Pulmonary Embolism
Pınar Çimen, Dursun Alizoroğlu, Mehmet Ünlü, Cenk Kıraklı, Özlem Ediboğlu, Ahmet Emin Erbaycu
doi: 10.14744/etd.2019.80008  Pages 175 - 179
Objective: Thrombolytic and anticoagulation therapy modalities are the possible treatment for submassive pulmonary embolism (PE). However, the indications are still the subject of debate. The aim of the present study was to compare the efficacies of thrombolytic and standard anticoagulation treatment modalities on mortality and also to determine the safety of thrombolytic treatment in subjects with submassive PE.
Materials and Methods: Subjects with submassive PE were recruited from the intensive care unit (ICU). Demographic data, comorbidity, bedside echocardiography (ECHO) findings, treatment procedure, treatment-related side effects, and total length of stay in the hospital and ICU were collected. Control ECHO was performed 48 h after the initiation of treatment. Short-term and 1-year mortality rates were recorded. The correlation between the increased risk for major bleeding and thrombolytic treatment was assessed.
Results: A total of 54 subjects were enrolled during the study period. The median age of the subjects was 66 (54–73) years. Of the 54 subjects, 18 (33.3%) underwent thrombolytic treatment, and 36 (66.7%) received standard anticoagulation therapy. Short-term and 1-year mortality rates were statistically lower in subjects who received thrombolytic therapy (p=0.02 and p=0.04, respectively). The reduction in mean pulmonary arterial pressure was significantly higher in the thrombolytic treatment group (p<0.001). Risk for major bleeding was similar between the two.
Conclusion: Thrombolytic therapy may reduce the mortality rates in subjects with submassive PE without an increase in the risk of major bleeding.

12.Evaluation of Obesity with Vitamin D Levels and Related Parameters
Aybike Gizem Kayacan, Neslihan Sürmeli, Mehtap Ünlü Söğüt, Elanur Yılmaz
doi: 10.14744/etd.2019.92609  Pages 180 - 185
Objective: This study aimed to investigate the relationship between vitamin D levels, biochemical findings, and body analysis data of adult individuals, and effects of seasonal vitamin D level differences on these relationships.
Materials and Methods: In this retrospective study, medical records of 159 individuals who applied to Samsun Büyük Anadolu Hospital Nutrition and Dietary Polyclinic were examined. The serum 25(OH)D levels were defined as <10 ng/ml vitamin D deficiency; 10–20 ng/ml vitamin D insufficiency; and >20 ng/ml normal vitamin D level. Vitamin D levels were also divided into two according to seasons: summer and winter.
Results: Of the 159 participants included in the study, 42 were overweight and 94 were obese. Vitamin D deficiency was found in 21.4% and vitamin D insufficiency was found in 35.2% of the patients. Winter vitamin D levels were significantly lower than summer vitamin D levels. Vitamin D levels decreased with increasing body fat mass and percentage, abdominal fat mass and percentage. Individuals with vitamin D deficiency had higher body mass index than individuals with vitamin D insufficiency. Vitamin B12 levels of individuals with vitamin D deficiency were found to be significantly lower. Aspartate aminotransferase levels of individuals with vitamin D deficiency were higher than individuals with vitamin D insufficiency.
Conclusion: Vitamin D deficiency and insufficiency varies according to sunbathing times in summer and winter season and it is quite common in obese patients. Strategies should be developed to prevent and control obesity and to combat the inadequacy of vitamin D nutritional status.

13.Level of Serum Adiponectin in Sjögren’s Syndrome
Kübra Doğan, Muhammed Emre Urhan, Şeymanur Yıldız, Mehmet Emin Derin, Ali Şahin, Halef Okan Doğan
doi: 10.14744/etd.2019.26214  Pages 186 - 190
Objective: To evaluate the serum adiponectin level and determine the association between adiponectin and various clinical and laboratory findings in patients with primary Sjögren’s syndrome (pSS).
Materials and Methods: A total of 50 patients and 30 healthy volunteers were enrolled in the present study. Serum adiponectin levels were detected by colorimetric enzyme-linked immunosorbent assay. The medical history of patients including complete blood count analysis; high sensitive C-reactive protein; erythrocyte sedimentation rate (ESR); complement component 3; complement component 4; low density lipoprotein cholesterol; triglyceride; immunoglobulin G (IgG), IgA, and IgM levels; and the status of Ro 60, Ro 52, Sjögren’s syndrome A, Sjögren’s syndrome B, and rheumatoid factor were obtained from laboratory information system.
Results: Serum adiponectin levels were 2.34 (0.77–4.95) ng/mL and 1.73 (0.01–7.76) ng/mL in patients and controls, respectively (p=0.316). Positive correlation was observed between the values of serum adiponectin, ESR (p=0.013, rho=0.362), and body mass index (p=0.018, rho=0.362) in patients.
Conclusion: These findings indicate that adiponectin does not play a crucial role in the immunological and clinical patterns of pSS.

14.The Impact of Lymphovascular Invasion on Recurrence-Free Survival in Patients with High-Risk Stage II Colorectal Cancer Treated with Adjuvant Therapy
Oktay Bokurt, Sedat Tarık Fırat, Ender Doğan, Mevlüde Inanç, Kemal Deniz, Gözde Ertürk Zararsız, Metin Özkan
doi: 10.14744/etd.2019.26779  Pages 191 - 195
Objective: Lymphovascular invasion (LVI) may affect disease recurrence after operation for colorectal cancer (CRC). Whether LVI is an exact prognostic variable remains uncertain. This research aimed to investigate the relationship between clinicopathologic factors, disease-free survival (DFS), and overall survival (OS) in patients with high-risk stage II colon cancer who underwent adjuvant treatments, focusing on LVI.
Materials and Methods: This study retrospectively investigated 173 patients who underwent operation for stage II tumors from September 2000 and December 2013. All patients received postoperative adjuvant therapy. The distinction among factors was calculated by a chi-square test. Survival probabilities were predicted with the Kaplan–Meier method, and group comparisons were applied with the log-rank test. Furthermore, univariate and multivariate cox regression analysis were used to determine the most substantial risk elements.
Results: LVI was identified in 26 of 173 patients (15%) and was significantly related with positive perineural invasion (PNI) (p<0.001). There were no considerable differences among LVI and other clinicopathologic factors. LVI-positive patients had significantly lower DFS than LVI negative patients, with a hazard ratio of 2.83 (95% CI 1.24–6.48). The five-year survival rate of the LVI-positive group was substantially lower than for those who were LVI negative (p=0.004).
Conclusion: In this research, LVI was a meaningful prognostic variable for DFS, but not for OS. This study revealed a prognostic value of LVI for DFS in patients with high-risk stage II tumor who underwent adjuvant treatments.

15.Levothyroxine Dosage Determination According to Body Mass Index (BMI) After Total Thyroidectomy
Hemmat Maghsoudi, Seyed Ehsan Mousavi Toomatari, Naser Agha Mohammadzade, Farzad Najafipour, Sara Akhavan Salamat, Seyed Babak Moosavi Toomatari, Afshin Gharekhani
doi: 10.14744/etd.2019.14892  Pages 196 - 200
Objective: Currently, postoperative thyroid hormone replacement dosing is weight-based with adjustments and made following Thyroid Stimulating Hormone (TSH) values, which may lead to delayed achievement of euthyroidism and failure in achieving an accurate estimation of the levothyroxine dose. We aimed to evaluate the relationship between Body Mass Index (BMI) and Lean Body Mass (LBM) with levothyroxine dose.
Materials and Methods: Eighty patients with thyroid disease (benign and malignant) randomly enrolled the study. BMI and LBM were calculated during the pre-operative visit. Thyroid hormone replacement was started five day after surgery for benign and after a month for malignant cases, at a dose of 1.6 mcg/kg/day based on actual body weight. When euthyroidism was achieved, the levothyroxine dose was measured, and efforts were made to analyze its relationship with weight, BMI, and LBM.
Results: In the benign group, levothyroxine dose was obtained at 1.51 mcg/kg per body weight. To determine the levothyroxine dose based on BMI and LBM, Y=–0.013+0.005 BMI and Y=0.048+0.002 LBM formulas were used, respectively. In the malignant group, a levothyroxine dose of 1.56 mcg/kg was obtained based on the weight variable. To determine the levothyroxine dose based on BMI and LBM, Y=0.01+0.004 BMI and Y=0.042+0.002 LBM formulas were used, respectively. In both groups, the levothyroxine dose that was calculated was more accurate using BMI with the obtained formula.
Conclusion: Weight, BMI, and LBM can be used to determine the levothyroxine dose in patients receiving total thyroidectomy, but levothyroxine can be precisely measured using BMI.

BRIEF REPORT
16.Human Anthrax in Kazakhstan From 2016 to 2018
Saule Maukayeva, Gulnar Nuralinova, Karina Issembayeva
doi: 10.14744/etd.2019.46658  Pages 201 - 204
Abstract | Full Text PDF

CASE REPORT
17.Successful Management of Post-traumatic High-Flow Priapism by Super-Selective Coil Embolization: A Case Report
Mohamed Ahmed Abd El Salam, Shady Nabil Mashhour, Omar Abdulsalam Azzazi
doi: 10.14744/etd.2019.78557  Pages 205 - 208
Priapism is a rare andrological emergency characterized by a prolonged penile erection that is not provoked by sexual excitation or stimulation and lasts longer than 4 hours. There are three different types of this emergency that can be encountered in clinical practice based on the episode history and pathophysiology, including veno-occlusive (ischemic or low-flow priapism), arterial (non-ischemic or high-flow priapism), and stuttering priapism. High-flow priapism is the less common type, which accounts for approximately 5%–10% of cases. This type is caused mainly by trauma to the penis, perineum, or a pelvis fracture that may lead to an arterio-cavernous fistula or pseudoaneurysm with a subsequent uncontrolled arterial inflow to the penis. This type of emergency is under-reported, and a low number of cases have been documented. Therefore, the effectiveness, encountered risks, as well as management outcomes are still limited. Hereby, we report a case of a 29-year-old male who presented to the emergency department complaining of a persistent painless penile erection for 2 weeks following perineal trauma (falling astride). A multidisciplinary clinical evaluation and management by a selective embolization technique are discussed in this case report.

18.Root Canal File Stick Into the Epiglottis: A Dangerous Complication of an Endodontic Procedure
Kerem Kökoğlu, Tuğrul Arslan, İmdat Yüce, Sedat Çağlı
doi: 10.14744/etd.2019.97830  Pages 209 - 211
Root canal treatment is one of the most frequently performed operations in dentistry. Some complications regarding the instruments used during operation include breakage of root canal file, inhalation, or ingestion. There are some reports in the literature on ingestion of dental instruments, and these could be life threatening because of the possibility of airway obstruction or tubular organ perforation. In this paper, an interesting case of root canal file stick into the epiglottis and its management are presented.

19.Benign Paroxysmal Positional Vertigo Following Electroconvulsive Therapy
Leyla Kansu
doi: 10.14744/etd.2019.26937  Pages 212 - 214
Patients with severe major depression most commonly undergo electroconvulsive therapy (ECT). Although this procedure is usually safe and the complication rates are very low, some side-effects and medical complications are observed. The reported adverse effects are generally minor in severity, and vertigo is one of these complications. We presented a case of benign paroxysmal positional vertigo (BPPV) occurring after ECT and aimed to discuss the pathophysiological mechanism of this condition. To the best of our knowledge, there are no other case reports regarding the co-occurrence.

20.Tick in Both External Auditory Canals: An Extremely Rare Case Report
Deniz Avcı
doi: 10.14744/etd.2019.75735  Pages 215 - 217
Foreign bodies in the external auditory canal (EAC) are common conditions experienced in the otorhinolaryngology practice. The most commonly implicated foreign bodies in EAC include cotton bud, paper, legume, fruit seed, nuts, toy parts, pen tip, and rubber. However, living objects are rarely reported. The presence of a tick in both EACs is extremely rare. In this report, we present a 55-year-old female patient who was detected with tick in both EACs, which is an extremely rare case in the literature. In the patients presenting with the symptoms of foreign bodies in EAC, living objects should be kept in mind, particularly those lead to serious morbidity and mortality such as ticks that are mostly presented by people living in rural areas. Doctors in endemic and rural areas should be more careful about this issue.

21.Rare Complications of Silica Dust Exposure
Alaa Omar Shalaby, Khaled Mahmoud Kamel, Ahmed Serag Aldein Al Halfawy, Hassan Mahmoud Amin, Sabah Ahmed Hussein, Hassan Gamal Yamamah, Hoda Mohamed Abdel-hamid
doi: 10.14744/etd.2019.38278  Pages 218 - 219
Crystalline silica inhalation causes silicosis, one of the ancient occupational lung diseases. It leads to an irreversible fibrotic response in the lung parenchyma and, consequently, causes diffuse interstitial lung disease. Asymptomatic to chronic irreversible forms are various presentations of silicosis, which has a high-risk predisposition to various comorbidities. We documented two cases of rare presentations of silica dust exposure alveolar silicoproteinosis and silicotuberculosis.

IMAGE
22.Phenytoin-Induced Gingival Enlargement
Satvinder Singh Bakshi
doi: 10.14744/etd.2019.86422  Page 220
Abstract | Full Text PDF

LETTER TO THE EDITOR
23.A histogenetic view inside the ICD-O A Histogenetic View of the International Classification of Diseases for Oncology Melanomas
Luca Roncati, Francesco Piscioli
doi: 10.14744/etd.2019.80388  Pages 221 - 222
Abstract | Full Text PDF

HISTORY OF MEDICINE
24.Physical Examination Signs of Inspection and Medical Eponyms in Pericarditis Part I: 1761 to 1852
Fan Ye, Halil Tekiner, Eileen Yale, Joseph Mazza, Steven Yale
doi: 10.14744/etd.2019.44342  Pages 223 - 229
The history of pericarditis involves the recognition of signs and symptoms detected using the physical examination skills such as inspection, palpation, percussion, and auscultation. Pericarditis is the term used to describe the spectrum of diseases that includes acute, subacute, and chronic forms. From 1761 to 1852, physicians were required to use their sense of sight, identifying abnormalities recognized as the signs of medical eponyms attributed to honor their findings. In this first part of a three-part series on pericarditis, the signs detected through inspection are described. Through inspection, physicians identified the bulging or retraction of the precordium and epigastrium in patients with pericardial effusion or adherent pericarditis. Many of these signs were detected, described, and reported in patients with advanced or chronic adherent pericarditis. It is unknown how useful these signs are in modern-day clinical practice.

25.Physical Signs of Inspection and Medical Eponyms of Pericarditis Part II: 1864 to 1895
Fan Ye, Halil Tekiner, Eileen S Yale, Joseph J Mazza, Steven Yale
doi: 10.14744/etd.2019.37659  Pages 230 - 234
During the mid- to late eighteenth century, physicians continued to make significant contributions describing their observations identified on physical examination in patients diagnosed with pericardial effusion or adherent pericardium. These diagnostic findings were eponymously named as signs in recognition of and to honor the contribution of physicians. The signs involve observation of the abdominal and chest wall during respiration and cardiac contraction, as well as changes occurring in the jugular veins during the cardiac cycle. These signs assisted physicians to further confirm the diagnosis and explain the pathogenesis of the underlying disease at a time where there were no imaging tests available. Observation of the height of the jugular venous wave and movements of the chest and abdomen wall during the cardiac and respiratory cycles provided physicians during this time period additional methods to detect pericardial effusion or adhesive pericarditis and mediastinitis. These findings depicted as sign of medical eponyms further enhance our understanding of the pathophysiological mechanism of disease. The absence of studies on these signs leads to a lack of insight about their accuracy and usefulness in modern-day clinical practice.

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